Are Geri chairs covered by Medicare? Understanding your coverage

According to the Centers for Medicare & Medicaid Services, certain durable medical equipment (DME) is covered under Medicare Part B, but the rules are very specific for mobility devices like Geri chairs. Understanding if and how Geri chairs are covered by Medicare is critical for seniors seeking supportive seating solutions.

Quick Summary

Medicare Part B may cover the motorized seat-lift mechanism of a Geri chair, but not the entire chair itself, provided it is deemed medically necessary by a doctor for an eligible condition.

Key Points

• Partial Coverage: Medicare Part B covers the motorized seat-lift mechanism of a Geri chair, but not the entire chair itself.

• Medical Necessity Required: You must have a doctor's prescription and a diagnosis of severe arthritis or a neuromuscular disease that makes standing from a chair difficult.

• DME Guidelines: The Geri chair's lift mechanism is classified as Durable Medical Equipment (DME) and must meet specific Medicare criteria for coverage.

• Out-of-Pocket Costs: You will be responsible for the 20% coinsurance on the approved amount for the lift mechanism, plus the full cost of the chair and any uncovered accessories.

• Use Approved Suppliers: To ensure coverage, you must obtain the chair from a Medicare-approved supplier that accepts assignment.

Geri Chairs as Durable Medical Equipment (DME)

To understand Medicare's policy on Geri chairs, it's essential to grasp how the program classifies durable medical equipment (DME). The government defines DME as reusable medical equipment that is necessary and appropriate for use in the home, prescribed by a doctor, and can withstand repeated use. Geri chairs, or medical recliners, can fall into this category, but only partially.

The Breakdown: What Medicare Does and Doesn't Cover

Medicare Part B, which covers medical insurance, is the component that addresses DME. However, when it comes to Geri chairs, Medicare makes a crucial distinction: it covers the motorized seat-lift mechanism, but not the actual chair frame, upholstery, or other comfort-focused features.

The seat-lift mechanism is the part considered medically necessary, as it assists an individual in moving from a sitting to a standing position. This prevents falls and allows for greater independence. The rest of the chair—which is typically designed for comfort and aesthetics—is considered non-essential and must be paid for out-of-pocket by the beneficiary.

Qualifying for Coverage: The Path to Approval

To secure Medicare coverage for the seat-lift mechanism, you must meet specific medical and procedural requirements. Simply wanting a Geri chair for comfort is not enough. The process involves multiple steps to prove medical necessity:

• Doctor's Assessment: You must have a face-to-face examination with your physician, who will assess your medical condition and mobility challenges.
• Qualifying Medical Conditions: You must have severe arthritis in the hip or knee, or a severe neuromuscular disease that prevents you from standing up from a traditional chair on your own.
• Mobility Requirements: It must be proven that while you cannot stand from a regular chair without assistance, you are still able to walk independently once you are upright, even if with the aid of a cane or walker.
• Home Use: The chair must be for use in your home, not a skilled nursing facility or hospital, as care in those settings is covered differently.
• Medical Necessity Form: Your doctor must complete and submit a Certificate of Medical Necessity (CMN) to Medicare on your behalf.
• Approved Supplier: You must purchase the Geri chair through a Medicare-approved supplier who accepts the Medicare assignment.

Comparing Your Options: Geri Chair vs. Manual Recliner

When considering a Geri chair, it's helpful to understand how its features compare to a standard recliner, especially regarding Medicare's perspective.

Feature	Geri Chair (Medical Recliner)	Standard Manual Recliner
Purpose	Assistive mobility and support	General comfort and relaxation
Lift Mechanism	Motorized seat lift (potentially covered by Medicare)	No lift mechanism
Adjustability	Multiple positions, often including Trendelenburg	Limited recline positions, requires manual effort
Medical Needs	Designed for individuals with severe arthritis or neuromuscular issues	Suitable for general use, no medical requirements
Coverage	Lift mechanism may be covered by Medicare Part B	Not covered by Medicare
Cost	Higher initial cost, but can be offset by Medicare coverage for the lift	Typically lower initial cost

The Cost: What to Expect

Even with Medicare coverage, you will still have out-of-pocket costs. For the covered seat-lift mechanism, Medicare Part B typically pays 80% of the approved amount after you have met your annual deductible. You are responsible for the remaining 20% coinsurance, plus the full cost of the non-covered parts of the chair. You must also pay for the Part B deductible if you haven't already met it for the year.

It is crucial to work with a Medicare-approved supplier who accepts assignment. A supplier who accepts assignment agrees to accept Medicare's approved amount as full payment for the covered part of the service. If they do not, you could be charged more.

How to Get Started with Your Claim

If you and your doctor have determined that a Geri chair is medically necessary for you, the process begins by visiting a Medicare-approved Durable Medical Equipment supplier. The supplier, not the patient, typically files the claim with Medicare on your behalf.

1. Doctor's Visit: Schedule a face-to-face appointment with your physician to get a written prescription stating the medical necessity of the lift mechanism.
2. Supplier Selection: Find a DME supplier that is enrolled with Medicare and accepts assignment for the device.
3. Documentation: The supplier will work with your doctor to obtain all necessary documentation, including the Certificate of Medical Necessity (CMN).
4. Prior Authorization: For certain types of mobility devices, including some lift chairs, prior authorization may be required from Medicare. Your supplier should handle this process for you.
5. Rental vs. Purchase: Some DME items are initially rented, with Medicare covering a portion of the monthly rental fee. After a certain period, you may assume ownership of the device. Be sure to clarify the rental or purchase arrangement with your supplier.

The Importance of Documentation

Thorough and accurate documentation is the single most important factor for securing Medicare coverage. Any missing or incomplete information can result in a denial of your claim. The documentation must clearly state:

• The specific medical condition being treated.
• Why the lift mechanism is medically necessary.
• Confirmation of the in-home use requirement.
• Verification that other mobility-enhancing treatments have been tried and failed.

For more detailed information on DME guidelines, you can visit the official Medicare website at www.medicare.gov. Consulting with a qualified healthcare provider and a certified DME supplier will ensure you navigate the process correctly and understand all potential costs involved. Understanding the nuances of your coverage can make a significant difference in both your quality of life and your finances.

Frequently Asked Questions

Does Medicare pay for the entire Geri chair?

No, Medicare does not cover the entire Geri chair. It only covers the motorized seat-lift mechanism, considering it durable medical equipment (DME). You must pay for the rest of the chair yourself, as it's considered non-medical.

What medical conditions qualify me for Medicare coverage for a Geri chair?

To qualify, you must have a face-to-face examination with a doctor who must document that you have severe arthritis of the hip or knee or a severe neuromuscular disease that makes it impossible to stand from a regular chair without help.

Do I need a prescription to get Medicare coverage for a Geri chair?

Yes, a written prescription or order from your physician is required. They must certify that the seat-lift mechanism is medically necessary for your condition and for use in your home.

Will Medicare cover a Geri chair if I am in a nursing home?

No, Medicare will not cover a Geri chair if you are in a skilled nursing facility, hospice, or hospital, as these facilities are responsible for providing any necessary equipment.

What is the difference between a Geri chair and a standard lift chair?

A Geri chair, or medical recliner, is specifically designed for long-term supportive seating, often with extra padding and adjustability. A standard lift chair primarily focuses on the lifting function to assist with standing, and the Geri chair's lift mechanism is the only part Medicare will cover, regardless of the chair type.

Will a Medicare Advantage plan cover a Geri chair differently?

Medicare Advantage plans are required to cover everything Original Medicare covers. However, your specific costs and network rules may vary, so you should contact your plan provider to confirm prior authorization requirements and in-network suppliers.

Who files the claim with Medicare for the Geri chair?

The Medicare-approved Durable Medical Equipment (DME) supplier, from whom you get the chair, will typically file the claim with Medicare on your behalf. You should confirm this with the supplier to ensure all necessary documentation is submitted correctly.